How to Manage Opioids and Medical Marijuana in Workers Comp Claims

While cannabis remains a Schedule l drug under federal law, nearly 30 states and the District of Columbia have legalized it in some form — with several more states about to. Meanwhile, laws and court decisions regarding medical marijuana are in a state of flux.

Despite the increased awareness and acceptance of medical marijuana, there is little scientific evidence that it is an effective treatment for workplace injuries. In addition, a medical doctor cannot prescribe medical marijuana but, depending on the state, may be able to order or recommend it so that an individual can get it at a dispensary. Dosages, potencies, chemical makeup, and routes of administration can also vary by dispensary and state.

For these reasons, medical marijuana is not yet common in workers compensation cases, but it is likely to gain popularity and impact claims as more states pass laws that legalize use. Another concern for employers is that medical marijuana use will impede employees’ ability to safely do their jobs, potentially resulting in injuries to themselves or others, or property damage.

Managing evolving risks with a flexible claims framework

A forward-thinking claims framework can provide businesses with an effective way to prepare for emerging treatments, like medical marijuana, and also pursue the best outcomes for injured employees. Key aspects of this framework include:

A data-driven approach to identifying high-risk claims.

When used effectively, data analytics can help flag high-risk cases early in the claim process. As an example, Liberty Mutual uses analytics to identify injured workers who may be at increased risk for opioid dependency. The company also tracks prescription patterns to identify physicians who may be prescribing opioids too early or frequently.

Deep understanding of the medical, legal, and regulatory environments.

Actively engaging with state medical advisory committees and government institutions, and monitoring state-specific legal and regulatory environments, helps employers remain in compliance and promote evidence-based care. For instance, when the CDC released draft opioid guidelines, Liberty Mutual’s regional medical directors proactively provided feedback during the comment period, raising concerns about several issues, some of which were addressed in the final guidelines. Liberty Mutual quickly incorporated the CDC’s guidelines into its workers compensation claims process to mitigate opioid dependence and misuse.

Communication early and often to promote evidenced-based care.

When a worker is injured, effective dialogue should immediately begin across all channels. A knowledgeable insurer knows when to ask the right questions, such as why a physician’s prescription isn’t adhering to CDC guidelines or if alternative treatment options should be considered. For example, if an injured worker is prescribed an opioid, a Liberty Mutual claims handler may initiate a conversation between the treating physician and a regional medical director or nurse case manager to discuss treatment. In the case of medical marijuana, if an injured employee asks to be reimbursed, the claims handler requests a roundtable discussion with claims, legal, and medical staff to determine if it’s the most suitable path. Claims handlers are also trained on how to effectively communicate with injured employees so they can explain why prescriptions may not be appropriate for them.

By selecting a workers comp insurer with the flexibility to quickly adapt to new treatment methods and other trends that impact claims and outcomes, employers can better manage potential challenges and protect the health and safety of employees.

 

This website is general in nature, and is provided as a courtesy to you. Information is accurate to the best of Liberty Mutual’s knowledge, but companies and individuals should not rely on it to prevent and mitigate all risks as as an explanation of coverage or benefits under an insurance policy. Consult your professional advisor regarding your particular facts and circumstance. By citing external authorities or linking to other websites, Liberty Mutual is not endorsing them.